Saline implants under the muscle for 25 years and have capsular contracture (grade 3) on one side. Chance of reoccurance?

Question

Is the reoccurrence rate of another cc high and if I explant and decide later to re implant-is that surgery more complicated?

Leland Deane, MD, FACS · Answer

Without knowing more specifics, the chance of repeat capsular contracture is higher if already present. You're in a good position, however, to remove the implants completely and let the situation resolve. The good thing is that the capsular tissue will soften without the implant present, so capsule removal is usually not needed. I'm happy to answer more questions virtually. Best of luck.

Mert Demirel, MD · Answer

Yes, capsular contracture can recur after revision surgery, especially if you have already had a grade 3 contracture. The exact risk varies depending on the cause, implant type, pocket, capsule condition, bleeding, biofilm/inflammation, and surgical technique.
After 25 years, the capsule may be thick or calcified, so evaluation is important. Treatment may include implant removal, capsulectomy or capsulotomy, implant exchange, pocket adjustment, and sometimes changing the implant plane or using additional support in selected cases.
If you remove the implants and later decide to re-implant, the second surgery can be more complicated than doing everything in one stage. The tissues may shrink, scar down, or become thinner, and the surgeon may need to recreate the pocket. That does not mean it cannot be done, but it may be less predictable.
Some patients are better candidates for implant removal and replacement at the same operation, while others may benefit from a staged approach, especially if the tissues are unhealthy, thin, infected, or if they are unsure whether they want implants again.
My advice would be to consult a board-certified plastic surgeon experienced in breast revision. Ask whether your capsule should be partially or fully removed, whether imaging is needed, whether changing implant type or pocket would reduce recurrence risk, and whether one-stage or staged surgery is safer for your tissues.

Julia Spears, MD · Answer

Thank you for your question. After 25 years with submuscular saline implants, you have had a relatively long period before developing a Grade III capsular contracture. Unfortunately, once a patient has developed a capsular contracture, there is an increased risk of developing it again with future implants, although recurrence is certainly not inevitable.

The risk depends on several factors, including the condition of the existing capsule, implant type and position, surgical technique, and whether the pocket needs to be modified during revision. Depending on what is found during surgery, treatment may involve implant exchange along with partial or complete removal of the capsule and/or adjustment of the implant pocket.

If you prefer to have the implants removed now and reconsider augmentation later, that is also a reasonable option. Re-augmentation after explantation is commonly performed. It can sometimes be more involved because the breast tissues and implant pocket will change after the implants are removed, and some patients may eventually benefit from a lift or other tissue reshaping.

An in-person examination with a board-certified plastic surgeon experienced in revision breast surgery is important to evaluate your capsule, breast tissue, skin quality, and implant position before deciding between implant exchange, explantation alone, or a staged approach.

Sugitha Seneviratne, MBBS, FRACS (Plas), FACCS · Answer

Hello alicewon,
Thank you for your question which is important to consider when you are planning revision breast implant surgery in the context of current capsular contracture. This is an issue which is debated by plastic surgeons and patients as many variables impact the risk of capsular contracture including the type of implant fill, shell configuration and pocket.You have had good implant longevity if the capsular contracture developed after a couple of decades and this suggests that you may have another couple of decades before you develop issues with replacement implants. In general terms, prostheses under muscle are associated with a lower capsular contracture rate than in any other pocket.Explantation followed by subsequent augmentation is not necessarily more complex. 
I suggest you seek the advice of a specialist plastic surgeon with experience in breast implant surgery who can provide you with information specific to your circumstances, following clinical review. Best wishes.

Robert M. Wald, Jr., MD · Answer

There are 2 problems with breast implants. They can rupture (deflate with saline implants) or develop excess scar tissue (capsular contracture). Both of these problems require a second operation. In most cases, there is only a small risk for recurrent scar tissue following capsulectomy. If one decides to remove both implants, there is no downside to replacing them later if desired.

Emre Guvercin, MD, FEBOPRAS · Answer

After 25 years with saline implants, developing a Baker Grade III capsular contracture on one side is not unusual, and fortunately it does not mean you are destined to develop another contracture after revision. The risk of recurrence depends largely on the surgical strategy, implant type, implant pocket, and individual healing characteristics. In general, recurrence rates are higher after simple capsule release alone and lower when a more comprehensive revision is performed, such as capsulectomy with implant exchange and optimization of the implant pocket.If you choose to explant now and re-implant later, that is certainly possible. The delayed re-augmentation procedure can be somewhat more complex because the tissues, capsule, and implant pocket may change after explantation, but experienced breast surgeons perform these staged procedures regularly. The complexity depends on how much breast tissue remains, skin quality, and whether a lift is needed at the time of explant or re-augmentation.
One important consideration is that if you explant and decide not to replace the implants immediately, many patients benefit from a Push-Up Lift at the time of explantation to reshape and support their own breast tissue. This preserves aesthetics while keeping future augmentation options open. If implants are reintroduced later, they can be placed into a more favorable and stable breast envelope.
Overall, while there is always some risk of recurrent capsular contracture after re-implantation, it is not necessarily high, and a well-planned revision can significantly reduce that risk. The decision between immediate exchange, explant alone, or staged re-augmentation should be based on your goals, tissue quality, and comfort with future surgery.

Gary M. Horndeski, MD · Answer

Once you have a capsular contracture then it is more likely that you will continue to have a capsular contracture if implants are placed again. What I recommend to you is explantation, waiting 3-6 months and then consider new implants placed in a different pocket.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Daniel Barrett, MD · Answer

Dear alicewo,

capsular contracture happens. In fact, every implant has a capsule form around it, its just a certain percentage develop thick capsules. There is a lot we don't know about it actually. Some think that bacteria that gets on the implant during insertion can increase the risk. Thats why we use a Keller Funnel in our practice to reduce that possibility. Our capsular contracture rate is less than 2% because we use a keller funnel as well as meticulous operating room techniques.

Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Carlos Alberto Ríos García, MD · Answer

After 25 years with saline implants, developing a grade 3 capsular contracture on one side is unfortunately not uncommon. Over time, the body can progressively thicken and tighten the capsule around the implant, leading to firmness, distortion, asymmetry, and discomfort.
The reassuring part is that capsular contracture can usually be treated successfully. However, there is always some possibility of recurrence because the body naturally forms scar tissue around any implant.
The recurrence risk depends on many factors, including:
* your healing tendency* implant age* implant placement* chronic inflammation or biofilm* surgical technique* implant type* and whether the capsule is fully or partially removed
In general, recurrence is possible, but many patients do very well for years after revision surgery, especially when the underlying causes are addressed carefully.
If you choose explantation now and later decide to re-implant, yes, the surgery can become somewhat more complex because:
* tissues may thin over time* scar tissue changes the anatomy* the pocket may contract or shift* and additional support or reconstruction techniques may sometimes be needed
That said, delayed re-augmentation is still commonly performed and can often be done safely in experienced hands.
In our practice, we frequently evaluate patients with long-standing implants and capsular contracture, and one of the most important decisions is determining whether your goals are best achieved with:
* implant exchange* total capsulectomy* explant alone* staged reconstruction* or delayed re-augmentation later on
There is not one single correct answer for every patient. The best choice depends on your anatomy, symptoms, tissue quality, and long-term goals.

Frank Agullo, MD · Answer

Your twenty-five year run on submuscular saline breast implants will more likely end the way it has with most other women, and a grade III capsule on one side at some point is probable. Recurrence rates vary based on what transpires in the operating room. Ideally a total capsular resection should be done on the affected side, with the pocket switched to a neo-subpectoral or fresh dual plane on clean tissue, and reinforcement along the lower pole with a GalaFlex Lite or ADM. With those interventions in place, recurrence drops into the single digits in most series I trust. Placing a new implant back inside the old scarred pocket without changing the plane is essentially playing the lottery.

About your second question, yes, separating explantation now from a later re-implantation will result in a more difficult second surgery than a one-stage exchange. The pocket scars down on you, the soft tissues thin while the breast sits unsupported, and a small fat graft is often added at the later session, possibly with a breast lift, to prepare the area before a new implant fits well.

One-stage versus staged depends on the photos taken in a consultation.

#StayBeautiful,

@RealDrWorldWide

Saline implants under the muscle for 25 years and have capsular contracture (grade 3) on one side. Chance of reoccurance?

Answers (13)

More Breast Implant Removal Questions

Breast Implant Removal and Hypertrophic Scar revision - what to consider?

Breast implant removal - would an explanting surgery cause more damage and decrease my ability to breastfeed?

Implants from 1998 - Do I need an explant?

Can I have an explant and lift in the same procedure? (Photos)

Explanting UTM implants when part of the pectoralis major muscle is missing: What to expect?

225cc silicon implant, left is ruptured. Would removal likely lead to deformity? (Photos)

WE SEND PRETTY
EMAILS